The majority of those who have worked with selenium have used it in colloidal form, either preparing it themselves or employing one of the preparations put on the market by the pharmaceutic firms. Of the latter the best known are the electro-selenium of Clin, and the Seleniol of Couturieux. Of those who have made use of selenium in these forms may be mentioned Cade and Girard,[283] Bougeaut and Galliot,[284] Blumenthal,[285] Thiroloix and Lancien,[286] Delbet, Laurent and Bohec,[287] and most extensively of all, M. Touche.[288] All of these authors have described cases of malignant new growths of the most varied character which were treated by these preparations.
The results obtained are fairly concordant. The intravenous injection of the preparation produces but slight disturbance. There is leukocytosis, a moderate rise of temperature, and not infrequently a chill. Otherwise the substance seems to possess no toxicity. The effects produced on the tumors have almost invariably been described as encouraging. Touche, who treated twenty-seven cases in this way and has described each case in detail, states that under the treatment the surface of the tumors, if ulcerated, became cleaner and healthier; the tumors became softer; the rate of growth was arrested, and there was relief of pain and of the accompanying functional disturbances; often, too, there was a gain in weight and an improvement in general well-being.
Touche concludes his article with the statement that “it is certain that the effect is not curative but it is actually palliative.” Delbet, on the other hand, states that he has seen no beneficial effects from the use of colloidal selenium injected intravenously. In the discussion on Delbet’s paper, Ledoux-Lebard states that he has observed nothing from selenium further than the temporary improvement which is shown by almost all cancer cases on the application of any new therapeutic measure. In one or two instances the claim is made in the literature of an actual cure of malignant growth through the use of selenium. Such, for example, is the case described by Blumenthal. From the clinical description this might have been a cancer of the tongue, and was judged to have been such in view of the negative Wassermann reaction. No microscopic examination was made. Arsphenamin was given. The patient recovered. It is clear that instances of this type cannot be accepted as beyond criticism, and it is safe to say that nothing more convincing in the way of actual cure is offered in the rather voluminous literature on the use of selenium.
Numerous compounds of selenium, some of them claiming to circulate in colloidal form, have been described, and have been put on the market for use in malignant disease. Such are Walker’s sulpho-selene, and selenio-vanadium, which has been prepared in the form of an ointment by Schering and Glatz. These preparations lay claim to the same palliative effects which have been previously described for colloidal selenium.
Of the other metals in colloidal form, chiefly silver and copper have come into use. Colloidal silver was first recommended for malignant growths by Vogel. It is obtainable on the market in proprietary form under the name of fulmargin, and also as electrargol. Recently Rohdenburg[289] has made a careful study of the effects of colloidal silver in experimental and in human tumors, and finds that they have no value. Colloidal copper has been used in recent times for the same purpose by Gaube du Gers and by others. I have recently examined the effects of colloidal copper on malignant tumors in man, and have been unable to find that it has any therapeutic value. Furthermore, a study of the distribution of the copper in tumors obtained at operation or by necropsy from individuals so treated failed to show that the copper had been deposited therein.
Finally, preparations similar to those used by Werner and by Caspari in animals have also been used in human beings. In these cases also the authors have been able to record palliative effects on the tumor, but in no instance cures.
We have seen that it has been quite impossible to duplicate in human beings the therapeutic technic employed in animal experiments. We have seen further that the use of a modified technic in animal experimentation has never been productive of favorable results even at the hands of enthusiastic adherents. In striking contrast to these conclusions are the observations made in human therapeutics. For every type of preparation described in the preceding paragraphs, the claim has been made practically without exception that it exercises a markedly beneficial effect on malignant diseases in the human being. Not only are the subjective symptoms alleviated, but also the tumors appear to become cleaner and softer; the rate of growth is retarded; necrosis and metastasis are prevented, and inoperable tumors become operable. How are we to interpret these observations? How are we to explain the fact that they are the almost invariable accompaniment of the most diverse methods of treatment? I have already quoted the statement of Ledoux-Lebard that every therapeutic novelty appears to exercise a favorable effect on cancer cases. The same fact has been observed in a variety of other diseases, such as locomotor ataxia.
In order to arrive at a safe and reliable estimate as to the value of any new or experimental procedure in cases of cancer, it seems advisable to accept certain definite therapeutic criteria by which the cases are to be judged. In the absence of such a method, alterations in symptoms which are actually of no real value or importance receive undue emphasis. The natural course of the disease is associated with such fluctuations that a sanguine therapeutist can gain some encouragement from even the most hopeless cases. Hence it follows that every mode of treatment has found adherents. The market is flooded with cancer drugs, and cancer charlatans flourish in the most highly educated communities. Unfortunately, even well trained, honest and reputable physicians have fallen victims to this fallacy, and have lent their names to the support of modes of treatment which in reality produce no determinable effect on the natural evolution of the disease. It was the desire to combat this unfortunate tendency which led me some time ago to attempt to establish a reliable set of criteria of therapeutic effects in cancer. These were embodied in an article[280] which appeared two years ago, and I may be here permitted to quote them in extenso:
CRITERIA OF THERAPEUTIC EFFECTS
In determining the effects of any given mode of treatment on a tumor, a variety of criteria may be relied on. Circulatory changes in the tumor, the relief of pain and the restoration of a secondarily impaired function are certain of the criteria on which stress has been laid by the majority of observers in the past. Important as are these criteria in determining the progress of purely inflammatory processes, it is unquestionable that their value in judging of the effects of therapeutic methods when applied to malignant disease is open to criticism. It is a curious and interesting fact that almost every therapeutic claim made in recent years in connection with cancer has included among its virtues the relief of pain. This is true of vaccination with cancer tissue, of Hodenpyl’s method and of many others. In view of this very general effect, not much stress can be laid on this symptom, and it is probably fair to assume that in the great majority of these cases the result is in no small measure psychic. The improvement of function is also largely a subjective phenomenon, and as such requires most careful criticism. Osler relates that he has known a patient with gastric cancer to be relieved of digestive disturbances and to gain 18 pounds in weight as the result simply of the visit of a sanguine consultant who denied the presence of a tumor. Improvement in the ability to chew food, to articulate words or to move a limb are phenomena familiar to those who attempt to treat cases of cancer. The victims of this disease seem to be in a very high degree “suggestible” and impressionable and respond nobly to every therapeutic effort.